"Keep Patient and Family at the Center": The Role of Social Workers in Family Meetings in Palliative Cancer Care

Background and purpose: Family meetings (or family conferences) are a structured clinical intervention in palliative care, which provide a venue for patients, families, and interdisciplinary team members to openly exchange information and concerns, discuss the patients’ condition and prognosis, clarify goals of care, and make decisions. Social workers are ideally to lead and facilitate family meetings due to their training in family systems, group dynamics, and distinctive clinical social work skills. However, our recent systematic review on family meetings found that physicians typically play the primary role in facilitating family meetings. Social workers may struggle to demonstrate and receive open acknowledgment of their roles in family meetings. The aim of this study is to identify the roles of social workers in family meetings in palliative cancer care.

Methods: Using convenience sampling, we recruited clinical social workers (n=19) involved in palliative cancer care who have an active role in family meetings in the United States through the Social Work Hospice and Palliative Care Network. Semi-structured interviews were conducted via Zoom between December 2024 and March 2025. All interviews were recorded and transcribed. Two authors independently reviewed the transcripts for accuracy and then conducted the analysis. Inductive thematic analysis was used to identify key themes.

Results: We identified five distinct roles played by social workers in family meetings: (1) Pre-meeting organizer: social workers determine and coordinate which healthcare providers and family members should be present, as well as manage logistics (e.g., timing, location). They also help formulate the meeting agenda. (2) Communication facilitator: social workers serve as a bridge between patients, families, and the healthcare team by clarifying medical jargon and ensuring that patients and families understand the intended messages. They check for understanding and redirect the conversation to stay focused on important issues. (3) Emotional supporter: social workers provider emotional support to patients and families, especially during times of sadness or crisis. They pay close attention to non-verbal cues and body language to understand emotions and reactions. This role includes active listening, offering validating statements, and being present in a supportive and compassionate way. (4) Advocator: social workers facilitate opportunities for families to voice their understanding and perspectives. They ensure the patient's and families’ expectations and goals are expressed and achieved. (5) Meeting follow-up coordinator: After the meeting, social workers debrief with healthcare providers to review the meeting process and offer feedback or insights. They also follow up with families to address any unmet needs and ensure continuity of care.

Conclusions and implications: These findings highlight that social workers are well- positioned to lead and facilitate family meetings, given the mission of the profession and the unique capability and skills they bring. There is urgent need for future efforts to raise awareness and promote these distinct roles and practices of social workers to enhance the quality of palliative care for patients and their families. The findings may also inform supervisors and educators about the training needs of individuals preparing to enter the rapidly growing workforce of palliative social workers.